How to Prevent and Treat Bedsores

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Bedsores, also known as pressure ulcers, happen when someone lies or sit in one position for too long, which cuts off blood supply and causes skin and tissue damage. Your loved one doesn’t have to be completely bedridden to get them, either. They can still get bedsores even if they’re able to walk, especially if they have a chronic condition such as heart disease or type 2 diabetes that affects their blood circulation and would make it difficult for a wound to heal.

It’s thought that at least one third of all hospice patients experience a wound such as a bedsore at the very end of their life. But bedsores are easy to spot, and, if caught early, can be treated—and even prevented—with minimal fuss.

Bedsore stages

People are most likely to get bedsores at the bony parts of their bodies, like heels, hips, the tailbone, shoulder blades, knees, and the back of the head. That’s because there’s very little fat to protect these areas.

Bedsores can be divided into four stages:

  • Stage 1: The skin is red, feels warm to the touch, and burns or itches.
  • Stage 2: The skin has turned into a painful, blistering sore. The surrounding skin may be discolored.
  • Stage 3: The sore looks like a large crater, due to increased tissue damage.
  • Stage 4: The sore is deep and open, and you can actually see through to muscle and bone. It may smell and you may see thick yellow or green pus due to infection.

If you think your loved one has a bedsore, you need to let their medical provider or hospice team know as soon as possible. They can examine the sore and check for blood or fluid, which may indicate infection. They can also look for additional sores. They may also take a blood test to check for infection.

Preventing bedsores

The best strategy is not to get bedsores in the first place. You can help prevent them with some simple moves:

  • Make sure your loved one is staying hydrated and getting good nutrition, as getting enough calories and protein is essential to keep skin healthy.
  • After they urinate or have a bowel movement, clean the area immediately and dry thoroughly. Urine is very acidic and allowing urine to remain on the skin can increase the risk of pressure ulcers.
  • Use a soft pillow between parts of the body that press against each other or the mattress (for example, if your loved one is lying on their side, put a pillow between their knees and ankles, and when they are lying on their back, put pillows under their heels, tailbone, shoulders, and elbows).
  • If they are sitting in a chair or wheelchair, make sure they are sitting on a foam or gel cushion specifically fitted to their wheelchair. They should also sit up straight, which will help them move more easily, to prevent sores. They should change positions every 15 minutes; if they can’t do that by themselves, help them. If they are transferring themselves out of the wheelchair, make sure they are lifting themselves with their arms, not dragging themselves.
  • Every day, check their body from head to toe, focusing on areas where pressure ulcers are most likely to form (heels, ankles, knees, hips, tailbone, elbows, shoulders, back of the head, and ears). Call their doctor or nurse if you see any possible signs of pressure ulcers.
  • Don’t give them a bath or shower every day, as it can dry out their skin. When washing them, use a soft, gentle cloth with a mild moisturizing soap. You should moisturize their skin every day.
  • Encourage them to stay as active as possible. Physical activity increases blood flow, which can help prevent pressure sores. Their hospice team can suggest some exercises to do in bed or in their wheelchair if they’re not mobile, or have a physical therapist come to work with you.

How to treat bedsores

It’s important to treat bedsores right away, as delaying care can lead to infection and possibly even septic arthritis, a joint infection that damages cartilage and tissue. If the sore has been caught early (stage 1 or 2) your loved one may only need antibiotic cream. If infection has spread into surrounding tissue or even the bone, they may require oral or IV antibiotics.

It’s crucial to take pressure off of the sore, so it can heal. You’ll need to change their position every two hours, to prevent them from putting too much pressure on any one spot. A foam mattress also better absorbs pressure.

You’ll need to keep the sore covered with a bandage, either moist gauze that’s changed daily or a newer type of dressing called hydrocolloid dressing, which is made of a gel that sticks to the sore. (This only needs to be changed every several days.)

When you change the bandage, you’ll need to clean the wound, so it doesn’t get infected or reinfected. You can clean stage 1 sores with soap and water and stage 2 sores with a salt and water solution, which flushes out any loose material. Stage 3 and 4 sores are more serious, and need to be cleaned by a doctor or a nurse (a process called debridement.)

Good nutrition is still important to keep skin healthy and prevent further tissue breakdown. It’s particularly important to get enough vitamin C and zinc, both of which help with healing.

As the pressure sore heals, it will gradually shrink and over two to four weeks you’ll start to see light red or pink lumpy, shiny tissue growing from it. This is the new, healthy tissue.

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